In Sierra Leone, a Fine Line Between Malaria and Ebola Symptoms

For many, the two diseases start out the same: a low fever, an aching body, vomiting and headaches. Sierra Leone’s Ministry of Health noticed that many of the country’s suspected Ebola cases were in fact malaria. So it launched a mass prophylaxis campaign, targeting many people who had never taken anti-malarials before. From Freetown, Cinnatus Dumbaya reports.

Malaria might be one of the biggest killers in Sierra Leone, but it’s also a regular occurrence. The 2013 World Malaria Report ranked Sierra Leone as the 5th most malaria-endemic country in the world. According to the Sierra Leone government’s own Malaria Indicator Survey in 2013, the disease was the leading cause of deaths in the country that year.

And yet, other than in the young, old or otherwise vulnerable, malaria is often regarded as a difficult but accepted part of life. Since Ebola broke out in Sierra Leone, however, malaria has become infused with more fear than before: the two illnesses, after all, often start out the same way, with deep headaches, fever, aching limbs, vomiting and diarrhea.

Musa Sillah Kanu, the head of surveillance at the National Malaria Control Program of the Sierra Leone Ministry of Health, said authorities decided to launch a malaria prophylaxis distribution campaign in order to curb confusion between the two diseases. The drug used was a combination of artesunate and amodiaquine, which has both preventative and curative powers.

“We found out that about 85 percent of cases at the Ebola holding centers turn out to be malaria cases,” said Sillah Kanu.

But some have voiced ethical concerns about distributing the drug without first conducting blood tests. Others have complained about side effects, and at least one man died after misunderstanding the dosage. Some people in remote villages reportedly fled into the forest, fearing that the program was a plot by authorities to infect them with Ebola.

“We got permission from the WHO [World Health Organization] to carry on with this method, because we are in a crisis,” Sillah Kanu told Ebola Deeply. “Carrying out a test ahead of time involves blood, and during Ebola we just don’t want to take the risk.”

Sheik Umar Sankoh, a 33-year-old resident of Freetown, took the medication.

“After I took those tablets my body became excessively weak, I felt so tired and dizzy,” he said. “I was just sleeping the whole day. I did not recover from that situation for like two days.”

Tenneh Kargbo, an elderly woman who lives in the Kissy Brook community in Freetown, echoed his concerns.

“The drug really made me weak,” she said. “It made me drowsy I had a headache and even sleepless nights after I took the tablets. I got worried that something bad might happen to me. But I was still convinced the government would not bring drugs that would kill us.”

Ramieu Gathia is the information, education and communication officer of MSF – the leading agency working on malaria drug mass distribution in western Sierra Leone.

He said the program was successful in cutting the number of suspected Ebola cases, despite concerns about the dosage and side effects of the medication. The second phase of the program, in late January, involved a lower dose.

“This time our 5,000 community health workers have done a good job in explaining better to the communities the drug prescription and dosage,” Gathia said. “We realized that the health education that was provided to the people was not enough or was not done in the appropriate way. In the second round, our community health workers went from house to house prior to the distribution to provide better health education.”

According to the Ministry of Health, four out of every 10 Sierra Leoneans have the malaria parasite in their blood at one time. The national malaria prevalence rate is 43 percent, but in some places, mainly districts such as Koinadugu and Kambia, it can reach as high as 60 percent.

The areas targeted during the program include Ebola and malaria hotspots in western Sierra Leone, as well as Bombali, Moyamba, Port Loko and Tonkolili.